Effectiveness of simple interventions to remind eye doctors to educate glaucoma patients about the dangers of driving

Purpose: A clinical audit to establish whether eye doctors achieve the benchmark in reminding glaucoma patients about the dangers of driving. After introducing two simple interventions, a follow-up audit was performed. Methodology: Initially, we interviewed 85 patients with established glaucoma who underwent Humphrey visual field (HVF) testing and also reviewed their medical notes. We looked for documentation of their driving status, specifically whether those with bilateral visual field (VF) defects recalled being given advice about the dangers of driving and whether this was documented in the notes. After this initial audit, doctors were educated on the availability of guidelines on visual requirements for driving, and reminder adhesive labels were put on the front of medical notes of driving glaucoma patients. A follow-up audit was then performed on 95 different patients. Results: In the initial audit, none of the patients had their driving status recorded. Only 36% of drivers with bilateral VF defects recalled being advised of the dangers of driving, with no documentation of whether the advice was given to them. Following the interventions, documentation of driving status became 86%. All drivers with bilateral VF defects recalled being advised regarding the dangers of driving, with documentation of the advice being given recorded in 73% of the medical notes. Conclusion: Eye doctors are inadequately identifying, advising, and documenting the dangers of driving in the medical notes of glaucoma patients with bilateral VF defects. This can be improved with simple interventions, such as the education of doctors and creating reminder labels, for the benefit of our glaucoma patients.

SITA standard testing with Humphrey visual field analyzer versus full threshold testing with frequency doubling perimetry: a comparison of patient preference and perception

Purpose: To compare patient preference for Swedish Interactive Threshold Algorithm (SITA) standard 24-2 protocol in Humphrey visual field analyzer (HVF) and full threshold N-30 protocol in frequency doubling perimetry (FDP) by primarily evaluating their perception about the test procedure and test targets along with surveying the factors that influence the patient concentration during perimetry and elements that determine the level of perimetry task difficulty. Methods: This study enrolled a subset of subjects from the Chennai Glaucoma Study. Each subject underwent a comprehensive ophthalmic examination after which they were randomly allocated to perform HVF and FDP with a 30-minute interval between the two procedures. SITA standard 24-2 protocol in HVF and full threshold N-30 protocol in FDP were used. This was followed by the administration of a questionnaire that mainly assessed the components such as (a) the patient preference for test procedure and test targets, (b) the factors influencing the patient concentration during perimetry performance, and (c) the impression about the level of perimetry task difficulty. The patient responses from the survey for each of the subcategories were obtained and analyzed using Chi-square test. Results: A total of 42 subjects with a mean age of 59.7 (SD 9.7) years were included, among which 18 (42.86%) were male and 24 (57.14%) were female. Thirty-two (76.19%) subjects felt both FDP and HVF were easy to perform, eight subjects (19.05%) felt that both perimetry techniques were difficult to perform, and two subjects (4.76%) found FDP procedure was easier than HVF, whereas the distribution was not statistically significant (Chi-square, p = 0.7). Pressing the button as a response to peripheral stimulus perception and inability to maintain steady central fixation for prolonged duration were the most commonly reported factors that influenced the level of difficulty of the perimetry tasks. A dark room ambience set for performing HVF was preferred by 32 (76.20%) subjects. Conclusion: There was no significant difference in the patient preference for test procedure and peripheral test targets. A black central fixation as in FDP and dark room ambience set for HVF were preferred.

Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects

Background/AimsHydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.MethodsData from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.ResultsSeventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.ConclusionPatients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.